Rescheduling OTC codeine could cost $316m a year: Guild

Written by Kate McDonald on 11 November 2015.

An independent economic evaluation of proposals to reschedule over the counter (OTC) combination analgesics containing codeine shows that it could cost the federal government up to $316 million a year, while the cost of an alternative real-time monitoring system would be negligible.

The Pharmacy Guild commissioned Canberra-based applied quantitative economic analysis firm Cadence Economics to look into the costs of the proposal, due to be decided by the Therapeutic Goods Administration (TGA) Advisory Committee on Medicines Scheduling this month.

The proposal is that OTC medicines containing codeine, such as combination painkillers and cold and flu tablets that are currently Schedule 2 (pharmacy only) or Schedule 3 (pharmacist only), be rescheduled to Schedule 4, which requires a doctor's prescription.

Figures from healthcare data firm IMS Health show that in 2014, there were approximately 16.4 million packs of analgesics containing codeine dispensed, and 5.2 million packs of codeine-containing cold and flu medications.

Cadence estimates that if OTC codeine rescheduling went through, 53 per cent of patients would elect to visit a GP to get a script for a codeine-based analgesic. Split between Level A and B consultations, this would cost the MBS an extra $316 million a year or over $1.26 billion over the final four years of the Sixth Community Pharmacy Agreement (6CPA).

The figures do not take into account patients seeking a script for the 5.2 million codeine-based cold and flu symptom relief medications – the conservative assumption is that most will instead purchase an alternative remedy at the pharmacy – and nor does it take into account losses in time and productivity for patients.

Costs to the PBS are also not included as these medications would not be subsidised, although Cadence says there is the potential that higher strength, PBS-subsidised alternatives such as Panadeine Forte might be prescribed more often.

Cadence Economics recommends that the federal government carefully consider the net costs of the rescheduling proposal, particularly in light of obvious lower-cost alternatives such as a register of OTC codeine medicines.

This system would allow pharmacists to record patients' details when purchasing OTC medications and review any other recent purchases in real time. If the patient doesn't consent, then the pharmacist will not supply.

A 2015 survey shows that 95 per cent of consumers would be willing to have their details recorded when buying OTC codeine products if it meant they could continue to be bought without a prescription.

A Guild spokesperson said the development costs for the system are about $300,000, with an estimated ongoing maintenance cost of about $300,000 a year.

“The Guild is not asking the government to pay these costs,” the spokesperson said. “They would be borne by industry.”